Provider Demographics
NPI:1639646391
Name:METCALF, AMANDA MAE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:METCALF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 NE B ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2108
Mailing Address - Country:US
Mailing Address - Phone:541-500-7111
Mailing Address - Fax:541-507-9118
Practice Address - Street 1:233 NE B ST STE 201
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2108
Practice Address - Country:US
Practice Address - Phone:541-500-7111
Practice Address - Fax:541-507-9118
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health